Background Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants. Methods We used data from 22 European cohort studies, which created a total study population of 367 251 participants. All cohorts were general population samples, although some were restricted to one sex only. With a strictly standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of particulate matter (PM) with diameters of less than 2.5 μm (PM2.5), less than 10 μm... (More)

Background Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants. Methods We used data from 22 European cohort studies, which created a total study population of 367 251 participants. All cohorts were general population samples, although some were restricted to one sex only. With a strictly standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of particulate matter (PM) with diameters of less than 2.5 μm (PM2.5), less than 10 μm (PM 10), and between 10 μm and 2.5 μm (PMcoarse), PM2.5 absorbance, and annual average concentrations of nitrogen oxides (NO2 and NOx) with land use regression models. We also investigated two traffic intensity variables-traffic intensity on the nearest road (vehicles per day) and total traffic load on all major roads within a 100 m buffer. We did cohort-specific statistical analyses using confounder models with increasing adjustment for confounder variables, and Cox proportional hazards models with a common protocol. We obtained pooled effect estimates through a random-effects metaanalysis. Findings The total study population consisted of 367 251 participants who contributed 5 118 039 person-years at risk (average follow-up 13.9 years), of whom 29 076 died from a natural cause during follow-up. A significantly increased hazard ratio (HR) for PM2.5 of 1.07 (95% CI 1.02-1.13) per 5 μg/m3 was recorded. No heterogeneity was noted between individual cohort effect estimates (I2 p value=0.95). HRs for PM2.5 remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 μg/m3 (HR 1.06, 95% CI 1.00-1.12) or below 20 μg/m3 (1.07, 1.01-1.13). Interpretation Long-term exposure to fine particulate air pollution was associated with natural-cause mortality, even within concentration ranges well below the present European annual mean limit value.

@article{2bc8bcc3-a1e0-48cd-b9f1-333c979500c6,
abstract = {<p>Background Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants. Methods We used data from 22 European cohort studies, which created a total study population of 367 251 participants. All cohorts were general population samples, although some were restricted to one sex only. With a strictly standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of particulate matter (PM) with diameters of less than 2.5 μm (PM<sub>2.5</sub>), less than 10 μm (PM <sub>10</sub>), and between 10 μm and 2.5 μm (PM<sub>coarse</sub>), PM<sub>2.5</sub> absorbance, and annual average concentrations of nitrogen oxides (NO<sub>2</sub> and NO<sub>x</sub>) with land use regression models. We also investigated two traffic intensity variables-traffic intensity on the nearest road (vehicles per day) and total traffic load on all major roads within a 100 m buffer. We did cohort-specific statistical analyses using confounder models with increasing adjustment for confounder variables, and Cox proportional hazards models with a common protocol. We obtained pooled effect estimates through a random-effects metaanalysis. Findings The total study population consisted of 367 251 participants who contributed 5 118 039 person-years at risk (average follow-up 13.9 years), of whom 29 076 died from a natural cause during follow-up. A significantly increased hazard ratio (HR) for PM<sub>2.5</sub> of 1.07 (95% CI 1.02-1.13) per 5 μg/m<sup>3</sup> was recorded. No heterogeneity was noted between individual cohort effect estimates (I<sup>2</sup> p value=0.95). HRs for PM<sub>2.5</sub> remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 μg/m<sup>3</sup> (HR 1.06, 95% CI 1.00-1.12) or below 20 μg/m<sup>3</sup> (1.07, 1.01-1.13). Interpretation Long-term exposure to fine particulate air pollution was associated with natural-cause mortality, even within concentration ranges well below the present European annual mean limit value.</p>},
author = {Beelen, Rob and Raaschou-Nielsen, Ole and Stafoggia, Massimo and Andersen, Zorana Jovanovic and Weinmayr, Gudrun and Hoffmann, Barbara and Wolf, Kathrin and Samoli, Evangelia and Fischer, Paul and Nieuwenhuijsen, Mark and Vineis, Paolo and Xun, Wei W. and Katsouyanni, Klea and Dimakopoulou, Konstantina and Oudin, Anna and Forsberg, Bertil and Modig, Lars and Havulinna, Aki S. and Lanki, Timo and Turunen, Anu and Oftedal, Bente and Nystad, Wenche and Nafstad, Per and De Faire, Ulf and Pedersen, Nancy L. and Östenson, Claes Göran and Fratiglioni, Laura and Penell, Johanna and Korek, Michal and Pershagen, Göran and Eriksen, Kirsten Thorup and Overvad, Kim and Ellermann, Thomas and Eeftens, Marloes and Peeters, Petra H. and Meliefste, Kees and Wang, Meng and Bueno-De-Mesquita, Bas and Sugiri, Dorothea and Krämer, Ursula and Heinrich, Joachim and De Hoogh, Kees and Key, Timothy and Peters, Annette and Hampel, Regina and Concin, Hans and Nagel, Gabriele and Ineichen, Alex and Schaffner, Emmanuel and Probst-Hensch, Nicole and Künzli, Nino and Schindler, Christian and Schikowski, Tamara and Adam, Martin and Phuleria, Harish and Vilier, Alice and Clavel-Chapelon, Françoise and Declercq, Christophe and Grioni, Sara and Krogh, Vittorio and Tsai, Ming Yi and Ricceri, Fulvio and Sacerdote, Carlotta and Galassi, Claudia and Migliore, Enrica and Ranzi, Andrea and Cesaroni, Giulia and Badaloni, Chiara and Forastiere, Francesco and Tamayo, Ibon and Amiano, Pilar and Dorronsoro, Miren and Katsoulis, Michail and Trichopoulou, Antonia and Brunekreef, Bert and Hoek, Gerard},
issn = {0140-6736},
language = {eng},
number = {9919},
pages = {785--795},
publisher = {Elsevier Limited},
series = {The Lancet},
title = {Effects of long-term exposure to air pollution on natural-cause mortality : An analysis of 22 European cohorts within the multicentre ESCAPE project},
url = {http://dx.doi.org/10.1016/S0140-6736(13)62158-3},
volume = {383},
year = {2014},
}